Pulmonary

Question 1

When does clubbing happen

Answer 1

malignancy, abscess, CF and fibrosis, it does NOT happen in COPD and prompts for need to search for malignancy

Question 2

MCC of digital clubbing

Answer 2

CF, malignancy, RL shunts in heart (megakarycytes shunted past pulm circulation)

Question 3

S/s of CHF versus COPD exas?

Answer 3

CHF will have bilateral crackles in the lower bases along with a dry cough and no production of sputum

Question 4

How do ABG in CHF compared to COPD

Answer 4

In CHF they have hypoxia, increased RR and alkalosis and hypocapnia as opposed to CHF with hypoxia, and hypercarbia due to CO2 retention and often a mild acidosis

Question 5

COPD exac ABG

Answer 5

Acidosis, hypoxia, hypercarbia

Question 6

Big thing that tells you something is COPD versus CHF

Answer 6

CO2 retention

Question 7

Are cultures needed in COPD exas?

Answer 7

No, just give antibiotics that are broad coverage, no sputum culture needed

Question 8

How can you tell COPD exas from PE

Answer 8

PE is more acute onset with more severe hypoxia, they also have LOW CO2 compared to CO2 retention in COPD. They always have metabolic alkalosis

Question 9

Does fibrosis cause decreased DLCO?

Answer 9

Yes, the fibrosis impairs gas exchange, there is low DLCO is fibrosis and emphysema, but not in COPD or asthma

Question 10

How does PE reduce preload to LV?

Answer 10

PE causes hypoxic vasoconstriction which increases pulmonary artery pressure and backs up to the weak right side of heart increaing pressure there, less blood gets to LV and there is decreased CO

Question 11

What are SABA used of antiLKT or ICS in exercise induced asthma?

Answer 11

If they exercise less than every day, or toelrate SABA, it is more effective. If they do daily or cannot tolerate SABA, LKT block or SABA

Question 12

In fibrosis/interstitial lung disease, what is DLCO like?

Answer 12

DLCO is REDUCED in interstitial lung diseases

Question 13

Who doens’t need assessment for blood tinged-sputum?

Answer 13

low risk, young, non somking patients that is not recurrent wthout history of lung diseases adn bleeding is not more than 30mL

Question 14

What does NPPV help in COPD

Answer 14

It is used when other intervention fail and CO2 rises as O2 supp will not reduce CO2 and NPPV decreases work of breathing and improves ventilation allowing lowering fo CO2

Question 15

Indication for pleural thoracostomy?

Answer 15

Less than 7.2 pH or glucose

Question 16

what do steroids do to blood counts, IE acute asthma?

Answer 16

Steroids cause lymphopenia of eosinophils and lymphocytes, but marginate neutrophils and increase these with over high Wbc

Question 17

What arhtymia does mitral stenosis commonly cause

Answer 17

mitral stenosis commonly causes afib in foreign, young adult early adult indivdiauls

Question 18

what is a common sign of enlarged LA

Answer 18

an enlarged LA such as in mitral stenosis causes elevation of left main stem bronchus and they commonly have afib

Question 19

What are s/s of OHS

Answer 19

obese patient with daytime HYPERCAPNIA with hypoxemia and often elevated hematocrit ; resulting in a respiratory acidosis

Question 20

In a new, high chance single respiratory nodule that was not present on previous CXR, what is always the first step?

Answer 20

No nodule not on previous CXR that has malignant features? CT no matter what, never biopsy first. CT CT CT